摘要:

Higher concentrations of free valproic acid and phenytoin have been reported in patients with uremia and liver disease. Free fatty acids also displace valproic acid and phenytoin. This is a study of the magnitude of displacement of valproic acid and phenytoin from protein binding by free fatty acid in lipemic sera. Higher concentrations of free fatty acids in lipemic sera affected protein binding of valproic acid significantly more than that of phenytoin. Supplementing normal sera with free fatty acids also increased the free concentrations of both valproic acid and phenytoin as expected, but the observed effect was several times higher in magnitude with valproic acid. There was an increased free fraction of valproic acid in patients who received valproic acid and had hypertriglyceridemia. In a patient with uremia, there was also a significant increase in free valproic acid concentration after routine hemodialysis caused by an increase in free fatty acid concentration secondary to hemodialysis. Increased protein binding of valproic acid in sera was observed after treatment with activated charcoal because charcoal can remove free fatty acid. Because higher free fatty acid concentration significantly affects protein binding of valproic acid, careful monitoring of free valproic acid in patients with lipid disorder may be beneficial.

ISSN:0002-9629    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Abnormalities of thyroid function are associated with hyperlipidemia, a risk factor for coronary artery disease that starts in childhood. We investigated the age-, race-, and sex-related differences in thyroid function and its relation to serum lipoprotein levels in children (n = 363) aged 6 to 18 years from the biracial (black/white) community of Bogalusa, Lousiana, using an ultrasensitive thyroid-stimulating hormone (TSH) assay. Serum levels of lipoprotein cholesterol fractions, triglycerides, triiodothyronine (T3), thyroxine (T4), and the Tanner stage of sexual development were determined. Serum T3 (P < 0.0001), T4 (P < 0.0001), and TSH (P < 0.0020) levels decreased significantly with Tanner stage. Serum T4 levels were significantly higher (P < 0.0001) in both black and white females than their male counterparts. An unexpected finding was a significantly increased mean serum TSH in whites (2.09 + 0.91; mean + standard error of mean) when compared to blacks (1.74 + 0.10; P = 0.0185). Overall, no significant correlation was noted between serum lipoprotein variables and TSH. However, those with the highest low-density lipoprotein to very low-density lipoprotein cholesterol fractions had a higher T4 and a T4/TSH ratio than those with the lowest low-density lipoprotein to very low-density lipoprotein cholesterol fractions. In summary, it is concluded that there is no simple relationship between lipoproteins and TSH or thyroid hormone levels in children.

ISSN:0002-9629    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Kidney length is commonly used to determine kidney size; however, its relationship to kidney volume is not well established. This study evaluated the association between kidney length and kidney volume. Eighteen healthy adults (9 men and 9 women) consented to take part in this prospective study; all 18 underwent spiral computerized tomography (CT) of the kidneys, 14 of 18 also underwent kidney ultrasound. Kidney volume was measured by totaling the areas of the CT scan cuts, and kidney length was measured both on the kidney ultrasound and on the CT scan. Each independent variable, CT length (CTL) and ultrasound length (USL), was regressed against the dependent variable, kidney volume. Kidney length explained only 10% of the variability of the volume, although length × width was a better predictor of kidney volume (r = 0.72, P < 0.001). It was concluded that kidney length does not reliably predict kidney volume and that other methods, both clinical and radiologic, should be considered when a more exact determination of renal volume is clinically relevant.

ISSN:0002-9629    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

As has been demonstrated, infusion of hydrochloric acid (HCl) and pepsin into the human esophageal lumen, which mimics the natural gastroesophageal reflux, results in a significant increase in salivary volume, salivary bicarbonate and epidermal growth factor. However, the impact of intraluminal acid/pepsin solution on salivary prostaglandin E2(sPGE2), the major protective factor of the upper alimentary tract, has never been explored. Therefore, using the newly developed esophageal perfusion model, the impact of both mechanical and chemical stimuli of the esophagus on sPGE2secretion in humans was studied.Salivary PGE2was assessed in saliva collected during basal conditions, chewing of parafilm, placement of intraesophageal tubing, inflation of intraesophageal balloons, and perfusion with sodium chloride, HCl, or HCl/pepsin solutions. The concentration of sPGE2was measured using the RIA kit from Amersham (Arlington Heights, IL) after the solid-phase extraction and derivatization.The concentration of sPGE2in the basal saliva was (mean ± standard error of mean) 186 ± 31 pg/mL and was similar during the chewing of parafilm (171 ± 32 pg/mL). The placement of intraesophageal tubing, however, resulted in a significant decline of sPGE2concentration to the value of 91 ± 22 pg/mL (P < 0.01). This decline was maintained when intraesophageal balloons, which compartmentalized a 7.5 cm perfused segment of the esophagus, were inflated (86 ± 17 pg/mL; P < 0.01). This decline was potentiated further when subsequent perfusion with saline was implemented to reach the lowest value of 46 ± 17 pg/mL (P < 0.001 versus basal and P < 0.05 versus tubing and balloon evoked values) at the end of the perfusing procedure. Esophageal perfusion with acid and acid/pepsin solution, however, partly restored the significant decline in sPGE2concentration observed during prolonged perfusion with saline.The sPGE2output during basal conditions was 89 ± 13 pg/min and increased dramatically during stimulation by placement of intraesophageal tubing (241 ± 48 pg/min; P < 0.01) and inflation of intraesophageal balloons (244 ± 48 pg/min; P < 0.01). Subsequent esophageal perfusion with saline resulted in a gradual decline of sPGE2output evoked by mechanical stimuli that reached the final value of 178 ± 39, which was not significantly different from that observed in the basal condition (P < 0.1 versus basal value). Introduction of HCl and pepsin into the perfusing solution significantly prevented the decline of sPGE2output observed during perfusion with saline (252 ± 36 pg/min; P < 0.01 versus basal).The modulatory impact of mechanical and chemical stimulation on sPGE2, demonstrated for the first time in humans, may suggest the potential contribution of salivary prostanoids to the maintenance of the integrity of the esophageal mucosa.

ISSN:0002-9629    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Very low birth weight preterm infants randomized to receive comprehensive primary care in an ongoing clinical trial were prospectively evaluated to determine the cause of frequent emergency room use despite the availability of a primary healthcare provider and specific social services. Mothers were interviewed to assess knowledge of available resources, when to seek medical attention, and the perception of problems that limit access to health care. The healthcare provider was not called before 49% of the emergency room visits and mothers often did not recall what infant signs needed medical attention. Seventy-nine percent of emergency room visits were delayed more than 10 hours; and 15 of 62 (24%) emergency room visits resulted in admittance to the hospital. We conclude that in high-risk populations, the mere availability of primary care does not assure that it will be used. New strategies to help parents know when and how to use services are needed to increase the delivery of primary care.

ISSN:0002-9629    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

In addition to the goal of controlling elevated blood pressure in patients with hypertension improving Dyslipidemia associated with insulin resistance may be an important element in preventing coronary artery disease. Antihypertensive treatment may differ based on the pathophysiology present. It appears that the evidence that supports the development of lipid abnormalities in patients who have insulin resistance is growing. In such patients the morbidity and mortality associated with coronary artery disease may be significantly decreased by selecting agents with favourable metabolic consequences.

ISSN:0002-9629    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Massive fibrinolysis after a liver transplant resulted in oliguric renal failure and necessitated the continuous infusion of large quantities of fresh frozen plasma. With the increase in plasma protein concentration, there was a simultaneous increase in the anion gap. These two parameters, the anion gap and total protein or albumin level in the blood, demonstrated a high degree of correlation. Weaker but significant correlations were found in a retrospective analysis of patients with a variety of renal diseases and a population of long-term peritoneal but not hemodialysis patients. This entity of hyperproteinemic acidosis should be added to the list of high anion gap acidoses.

ISSN:0002-9629    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

A 47-year-old woman with seronegative polyarthritis, diarrhea, and photosensitivity dermatitis was found to have Crohn's disease and pellagra. The presence of high values of 5-hydroxyindolacetic acid in the urine began the exhaustive investigations and finally enterotomy. No mass lesion was found. Argyrophilic cells were not increased in areas of inflamed intestinal mucosa or the normal mucosa. The disagreement between biochemical and histologic findings was attributed to sampling error. Antiinflammatory treatment for Crohn's disease was given and the gastrointestinal and articular symptoms improved, excretion of 5-hydroxyindolacetic acid returned to normal and there was no relapse of pellagra. Pellagra as a complication of Crohn's disease has been described in 4 cases; malnutrition and intestinal malabsorption were the proposed mechanisms for the niacin deficiency and pellagra of those patients. In the current case, the pathogenesis of pellagra may be accounted to wastage of tryptophan by an increased pool of intestinal argyrophilic cells, suggested by increased urinary excretion of 5-hydroxyindolacetic acid.

ISSN:0002-9629    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

A 25-year-old man with acquired Bartter's syndrome, mitral valve prolapse, and supraventricular tachycardia secondary to a low atrial focus was diagnosed with asthma. The unique aspects of managing these coexisting diseases are evaluated. Calculation of freewater clearance in the diagnosis of Bartter's syndrome and the etiology and characteristics of the syndrome are discussed.

ISSN:0002-9629    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Adverse effects of nonsteroidal antiinflammatory drugs are frequently seen because of the extremely widespread use of these agents. Nephrotoxicity is relatively uncommon with the drug ibuprofen and, when present, is usually rapidly reversible. Fatal acute renal failure from ibuprofen has never been reported. This is the case of a patient with multiple medical problems who had near-fatal acute renal failure after the ingestion of 36 g ibuprofen, and who required dialysis for several months, at which point renal function improved. He did not admit to ibuprofen ingestion at the time of admission, and some of the clinical manifestations, including anion gap metabolic acidosis, respiratory alkalosis, and mental status abnormalities, could be accounted for by renal failure. Hence, this diagnosis was not considered during admission. However, the patient admitted to ibuprofen ingestion after his mental status improved with hemodialysis. A number of other variables were present that probably contributed to the development of acute renal failure, such as the presence of long-term renal insufficiency, hypotension, and possibly other drug ingestion. Acute renal failure with massive ibuprofen ingestion may be fatal or may show delayed reversibility even after necessitating dialysis for several months.

ISSN:0002-9629    

出版商:OVID    

年代:1997

数据来源: OVID